The NHS autumn vaccine “invitations” have started arriving on our mobiles. If you’re over 65 or younger and immunocompromised, you’ll have been offered both a Covid and the flu jab. Pregnant women are also eligible for both vaccines and many surgeries are offering to do them on the same day.
For some people, this will be their fifth Covid jab. And while most of are keen to get our extra shot of immunity, we will know of a family member or friend who has quietly opted to give the vaccines a miss this time round.
North London GP Semiya Aziz has already experienced plenty of hesitancy when discussing the autumn boosters with her patients. This won’t have been helped by the recent news that the AstraZeneca Covid jab – which many of us received in the initial round – was ‘defective’, with claims over its efficacy “vastly overstated”.
“This year, I’m often being asked by older patients whether it’s absolutely necessary to have their Covid vaccination,” says Aziz. “Many of them feel bombarded with so many vaccines since the pandemic that there’s no further need to have any more. But Covid is still circulating among the general population, and people forget how the original rollout during the pandemic kept vulnerable people alive and out of hospital.”
The latest UK government data illustrates the ongoing threat posed by Covid-19. 607 people died from causes linked to Covid-19 in the first two weeks of October alone while between 10,000 and 25,000 people die from flu every year in the UK.
“I often have to remind patients how imperative it is that everyone eligible takes up their booster jabs this autumn,” says Aziz. “Vaccinations can help in preventing unnecessary hospitalisations and deaths arising from either flu or Covid over the winter months, especially amongst the most vulnerable.”
Here are the most common questions that doctors are hearing.
Do I really need a Covid jab this year?
According to the British Medical Journal, the BA.2.86 and XBB.1.5 variants are the most closely tracked variants currently circulating in the UK. BA.2.86 or the Pirola variant, is the newest with initial surges detected in September. While it contains certain mutations in the virus’ spike protein, there is no evidence yet that Pirola can circumvent vaccine protection and increase the severity of Covid-19.
Denis Nash, is an epidemiologist at the City University of New York. “Covid-19 can still severely affect people whose vaccine immunity has waned,” he says. “Many of the deaths are preventable and avoidable, it’s just that people, and particularly the elderly and vulnerable, are not up to date on their vaccines. This makes Covid a threat again.”
What are the various types of flu jab?
There are six different flu vaccines currently available in the UK, with some of them only suitable for certain age group ranges. For example, the Seqirus jab is typically (but not only) offered to over 65s. This jab includes a special immune-boosting chemical known as an adjuvant which is aimed at stimulating the older immune system.
Meanwhile, Astrazeneca’s Fluenz Tetra vaccine, which is available to eligible under 18s, provides immunisation via a nasal spray rather than an injection.
What Covid jabs are being offered?
According to the NHS, the three Covid jabs currently licensed for use in the UK are the Moderna and Pfizer jabs, as well as an additional option manufactured by Sanofi and GSK known as VidPrevtyn Beta. This Covid booster jab induces immunity to the spike protein found in the beta variant of Covid-19 which emerged in the summer of 2020. It also includes an additional adjuvant to stimulate an even stronger immune response.
AstraZeneca is no longer offered for Covid.
Should I have my flu and Covid vaccines together if offered?
Many people are now being offered “the double” – a Covid jab in one arm, and a flu jab in the other. This arrangement suits the NHS, as it’s more efficient and surgeries don’t need to send repeated reminders.
However, there has been anecdotal evidence that for some people, side effects can be more pronounced and last for longer when the jabs are received together, as opposed to having them on separate days.
“When you receive a vaccine, a flurry of immune cells called macrophages and neutrophils arrive at the site of the injection and begin producing inflammatory chemicals called cytokines,” says Robert Finberg, a professor of medicine at the University of Massachusetts Medical School. “This triggers a whole range of symptoms from swelling at the injection site, to fever, fatigue and chills. Doctors expect this cytokine reaction to happen any time a foreign substance is injected into the body.”
As a result, say experts, having two vaccines at the same time can exacerbate these symptoms, making you feel even more ill. Scientists still don’t fully understand why vaccine responses differ so much from person to person, but women typically have more vigorous immune responses compared to men, which can make them more prone to vaccine side effects.
But according to Dr Chris Smith, a consultant virologist at the University of Cambridge, you should still absolutely have “the double”, if the choice presents itself.
“It is the current best practice, supported by trials over the last couple of years,” he says. “Both provoke equivalent responses to isolated vaccines, but it’s more efficient to have both at once, so treatment rates are superior.”
What are the side effects likely to be?
The side effects of both vaccines are similar, with people often experiencing soreness at the site of the injection and aching muscles, symptoms which typically subside within one to two days. Occasionally, people will develop a temperature. NHS advice suggests that if your symptoms are prolonged and last more than a week, then call NHS 111.
“Side effects are often nothing barring mildly sore arms,” says Smith. “Sometimes lymph glands on the armpit and neck can swell transiently and can be tender. Some people feel tired for a day or two. In rare cases, there are more intense versions of these reactions, but most people are fine.”
Are side effects a sign that your immune system is working particularly effectively?
It’s extremely normal to experience side effects after a vaccine as they are signs of the body’s innate immune response – an inflammatory reaction aimed at clearing the vaccine particles from its system as quickly as possible. Sadly for those of us who would like to believe it, Smith says this initial reaction does not tell you anything about the likely long-term immune response.
“Different people mount different responses, and you cannot tell from subjective symptom reports what level of protection a person will develop,” he says.
I’m worried about the side effects. Should I space out my Covid and flu vaccines to minimise the side effects?
According to Aziz, this depends on how you have reacted to vaccines in the past. If you’ve previously experienced nasty side effects, then it might be a good idea to have them at different times.
“The fact that two vaccines have been administered at the same time may have more of an impact on the body, making the person feel even more unwell than usual,” she says. “It may be reasonable to offer the two vaccines separately, minimising the possible discomfort.”
How should I treat any side effects I experience?
The best approach, according to Smith, is simply to rest for a day or two, until you’re feeling better again.
“Managing them as you would do with the illness for real is a good rule of thumb,” he says. “Take it easy, rest up, get an early night and take paracetamol if necessary.”
Can having a vaccine lead to serious side effects?
New research based on data from Medicare claims in the US has found that in a handful of cases, having the Covid and flu vaccines at the same time can raise the risk of a stroke, but such incidents are exceedingly rare. The US Food and Drug Administration have said that the risk is vanishingly small, with just three strokes per 100,000 vaccine doses.
“All drugs have side effects and in very rare cases these can be severe,” says Smith. “But the reassuring aspect of these vaccines is that they have been given to literally billions of people with very good safety profiles, effectively making them better tested than almost any other drug on earth.”
How far in advance of a Christmas gathering should I have the jabs?
Aziz advises having your vaccine as soon as possible to ensure you have maximum protection ahead of Christmas parties and social events during the festive season.
“It usually takes one to two weeks for the body’s immurne system to kick in after either the flu or the Covid vaccine,” she says. “Hence the roll-out programme which has been offered starting in September and October, to allow ample time for the body to boost its immune system. The take-home message is, the sooner you get your vaccines, the better prepared you will be for forthcoming social events.”
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